What to do with diabetes therapies when HbA1c lowering is inadequate: add, switch, or continue? A MASTERMIND study
BACKGROUND:It is unclear what to do when people with type 2 diabetes have had no or a limited glycemic response to a recently introduced medication. Intra-individual HbA1c variability can obscure true response. Some guidelines suggest stopping apparently ineffective therapy, but no studies have addr...
| Main Authors: | , , , , , , |
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| Outros autores: | |
| Formato: | Journal article |
| Idioma: | English |
| Publicado: |
BioMed Central
2019
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| _version_ | 1826288197373526016 |
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| author | McGovern, A Dennis, J Shields, B Hattersley, A Pearson, E Jones, A Mastermind Consortium, |
| author2 | Farmer, A |
| author_facet | Farmer, A McGovern, A Dennis, J Shields, B Hattersley, A Pearson, E Jones, A Mastermind Consortium, |
| author_sort | McGovern, A |
| collection | OXFORD |
| description | BACKGROUND:It is unclear what to do when people with type 2 diabetes have had no or a limited glycemic response to a recently introduced medication. Intra-individual HbA1c variability can obscure true response. Some guidelines suggest stopping apparently ineffective therapy, but no studies have addressed this issue. METHODS:In a retrospective cohort analysis using the UK Clinical Practice Research Datalink (CPRD), we assessed the outcome of 55,530 patients with type 2 diabetes starting their second or third non-insulin glucose-lowering medication, with a baseline HbA1c > 58 mmol/mol (7.5%). For those with no HbA1c improvement or a limited response at 6 months (HbA1c fall < 5.5 mmol/mol [0.5%]), we compared HbA1c 12 months later in those who continued their treatment unchanged, switched to new treatment, or added new treatment. RESULTS:An increase or a limited reduction in HbA1c was common, occurring in 21.9% (12,168/55,230), who had a mean HbA1c increase of 2.5 mmol/mol (0.2%). After this limited response, continuing therapy was more frequent (n = 9308; 74%) than switching (n = 1177; 9%) or adding (n = 2163; 17%). Twelve months later, in those who switched medication, HbA1c fell (- 6.8 mmol/mol [- 0.6%], 95%CI - 7.7, - 6.0) only slightly more than those who continued unchanged (- 5.1 mmol/mol [- 0.5%], 95%CI - 5.5, - 4.8). Adding another new therapy was associated with a substantially better reduction (- 12.4 mmol/mol [- 1.1%], 95%CI - 13.1, - 11.7). Propensity score-matched subgroups demonstrated similar results. CONCLUSIONS:Where glucose-lowering therapy does not appear effective on initial HbA1c testing, changing agents does not improve glycemic control. The initial agent should be continued with another therapy added. |
| first_indexed | 2024-03-07T02:10:04Z |
| format | Journal article |
| id | oxford-uuid:a0532f54-62d7-4651-a3e7-5382b24e46b3 |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-07T02:10:04Z |
| publishDate | 2019 |
| publisher | BioMed Central |
| record_format | dspace |
| spelling | oxford-uuid:a0532f54-62d7-4651-a3e7-5382b24e46b32022-03-27T02:04:35ZWhat to do with diabetes therapies when HbA1c lowering is inadequate: add, switch, or continue? A MASTERMIND studyJournal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:a0532f54-62d7-4651-a3e7-5382b24e46b3EnglishSymplectic Elements at OxfordBioMed Central2019McGovern, ADennis, JShields, BHattersley, APearson, EJones, AMastermind Consortium,Farmer, ABACKGROUND:It is unclear what to do when people with type 2 diabetes have had no or a limited glycemic response to a recently introduced medication. Intra-individual HbA1c variability can obscure true response. Some guidelines suggest stopping apparently ineffective therapy, but no studies have addressed this issue. METHODS:In a retrospective cohort analysis using the UK Clinical Practice Research Datalink (CPRD), we assessed the outcome of 55,530 patients with type 2 diabetes starting their second or third non-insulin glucose-lowering medication, with a baseline HbA1c > 58 mmol/mol (7.5%). For those with no HbA1c improvement or a limited response at 6 months (HbA1c fall < 5.5 mmol/mol [0.5%]), we compared HbA1c 12 months later in those who continued their treatment unchanged, switched to new treatment, or added new treatment. RESULTS:An increase or a limited reduction in HbA1c was common, occurring in 21.9% (12,168/55,230), who had a mean HbA1c increase of 2.5 mmol/mol (0.2%). After this limited response, continuing therapy was more frequent (n = 9308; 74%) than switching (n = 1177; 9%) or adding (n = 2163; 17%). Twelve months later, in those who switched medication, HbA1c fell (- 6.8 mmol/mol [- 0.6%], 95%CI - 7.7, - 6.0) only slightly more than those who continued unchanged (- 5.1 mmol/mol [- 0.5%], 95%CI - 5.5, - 4.8). Adding another new therapy was associated with a substantially better reduction (- 12.4 mmol/mol [- 1.1%], 95%CI - 13.1, - 11.7). Propensity score-matched subgroups demonstrated similar results. CONCLUSIONS:Where glucose-lowering therapy does not appear effective on initial HbA1c testing, changing agents does not improve glycemic control. The initial agent should be continued with another therapy added. |
| spellingShingle | McGovern, A Dennis, J Shields, B Hattersley, A Pearson, E Jones, A Mastermind Consortium, What to do with diabetes therapies when HbA1c lowering is inadequate: add, switch, or continue? A MASTERMIND study |
| title | What to do with diabetes therapies when HbA1c lowering is inadequate: add, switch, or continue? A MASTERMIND study |
| title_full | What to do with diabetes therapies when HbA1c lowering is inadequate: add, switch, or continue? A MASTERMIND study |
| title_fullStr | What to do with diabetes therapies when HbA1c lowering is inadequate: add, switch, or continue? A MASTERMIND study |
| title_full_unstemmed | What to do with diabetes therapies when HbA1c lowering is inadequate: add, switch, or continue? A MASTERMIND study |
| title_short | What to do with diabetes therapies when HbA1c lowering is inadequate: add, switch, or continue? A MASTERMIND study |
| title_sort | what to do with diabetes therapies when hba1c lowering is inadequate add switch or continue a mastermind study |
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